Development and Application of Magnetically Controlled Capsule Endoscopy in Detecting Gastric Lesions

Efficacy and safety of three-dimensional magnetically assisted capsule endoscopy for upper gastrointestinal and small bowel examination

BACKGROUND

Magnetically assisted capsule endoscopy (MACE) showed the feasibility for upper gastrointestinal examination. To further enhance the performance of conventional MACE, it is necessary to provide quality-improved and three-dimensional images. The aim of this clinical study was to determine the efficacy and safety of novel three-dimensional MACE (3D MACE) for upper gastrointestinal and small bowel examination at once.

METHODS

This was a prospective, single-center, non-randomized, and sequential examination study (KCT0007114) at Dongguk University Ilsan Hospital. Adult patients who visited for upper endoscopy were included. The study protocol was conducted in two stages. First, upper gastrointestinal examination was performed using 3D MACE, and a continuous small bowel examination was performed by conventional method of capsule endoscopy. Two hours later, an upper endoscopy was performed for comparison with 3D MACE examination. The primary outcome was confirmation of major gastric structures (esophagogastric junction, cardia/fundus, body, angle, antrum, and pylorus). Secondary outcomes were confirmation of esophagus and duodenal bulb, accuracy for gastric lesions, completion of small bowel examination, 3D image reconstruction of gastric lesion, and safety.

RESULTS

Fifty-five patients were finally enrolled. The examination time of 3D MACE was 14.84 ± 3.02 minutes and upper endoscopy was 5.22 ± 2.39 minutes. The confirmation rate of the six major gastric structures was 98.6% in 3D MACE and 100% in upper endoscopy. Gastric lesions were identified in 43 patients during 3D MACE, and 40 patients during upper endoscopy (Sensitivity 0.97). 3D reconstructed images were acquired for all lesions inspected by 3D MACE. The continuous small bowel examination by 3D MACE was completed in 94.5%. 3D MACE showed better overall satisfaction (3D MACE 9.55 ± 0.79 and upper endoscopy 7.75 ± 2.34, p<0.0001). There were no aspiration or significant adverse event or capsule retention in the 3D MACE examination.

CONCLUSIONS

Novel 3D MACE system is more advanced diagnostic modality than the conventional MACE. And it is possible to perform serial upper gastrointestinal and small bowel examination as a non-invasive and one-step test. It would be also served as a bridge to pan-endoscopy.

As how artificial intelligence is revolutionizing endoscopy

With incessant advances in information technology and its implications in all domains of our lives, artificial intelligence (AI) has emerged as a requirement for improved machine performance. This brings forth the query of how this can benefit endoscopists and improve both diagnostic and therapeutic endoscopy in each part of the gastrointestinal tract. Additionally, it also raises the question of the recent benefits and clinical usefulness of this new technology in daily endoscopic practice. There are two main categories of AI systems: computer-assisted detection (CADe) for lesion detection and computer-assisted diagnosis (CADx) for optical biopsy and lesion characterization. Quality assurance is the next step in the complete monitoring of high-quality colonoscopies. In all cases, computer-aided endoscopy is used, as the overall results rely on the physician. Video capsule endoscopy is a unique example in which a computer operates a device, stores multiple images, and performs an accurate diagnosis. While there are many expectations, we need to standardize and assess various software packages. It is important for healthcare providers to support this new development and make its use an obligation in daily clinical practice. In summary, AI represents a breakthrough in digestive endoscopy. Screening for gastric and colonic cancer detection should be improved, particularly outside expert centers. Prospective and multicenter trials are mandatory before introducing new software into clinical practice.

Review article: Current status and future directions of ingestible electronic devices in gastroenterology

BACKGROUND

Advances in microelectronics have greatly expanded the capabilities and clinical potential of ingestible electronic devices.

AIM

To provide an overview of the structure and potential impact of ingestible devices in development that are relevant to the gastrointestinal tract.

METHODS

We performed a detailed literature search to inform this narrative review.

RESULTS

Technical success of ingestible electronic devices relies on the ability to miniaturise the microelectronic circuits, sensors and components for interventional functions while being sufficiently powered to fulfil the intended function. These devices offer the advantages of being convenient and minimally invasive, with real-time assessment often possible and with minimal interference to normal physiology. Safety has not been a limitation, but defining and controlling device location in the gastrointestinal tract remains challenging. The success of capsule endoscopy has buoyed enthusiasm for the concepts, but few ingestible devices have reached clinical practice to date, partly due to the novelty of the information they provide and also due to the challenges of adding this novel technology to established clinical paradigms. Nonetheless, with ongoing technological advancement and as understanding of their potential impact emerges, acceptance of such technology will grow. These devices have the capacity to provide unique insight into gastrointestinal physiology and pathophysiology. Interventional functions, such as sampling of tissue or luminal contents and delivery of therapies, may further enhance their ability to sharpen gastroenterological diagnoses, monitoring and treatment.

CONCLUSIONS

The development of miniaturised ingestible microelectronic-based devices offers exciting prospects for enhancing gastroenterological research and the delivery of personalised, point-of-care medicine.

Smart Endoscopy Is Greener Endoscopy: Leveraging Artificial Intelligence and Blockchain Technologies to Drive Sustainability in Digestive Health Care

The surge in the implementation of artificial intelligence (AI) in recent years has permeated many aspects of our life, and health care is no exception. Whereas this technology can offer clear benefits, some of the problems associated with its use have also been recognised and brought into question, for example, its environmental impact. In a similar fashion, health care also has a significant environmental impact, and it requires a considerable source of greenhouse gases. Whereas efforts are being made to reduce the footprint of AI tools, here, we were specifically interested in how employing AI tools in gastroenterology departments, and in particular in conjunction with capsule endoscopy, can reduce the carbon footprint associated with digestive health care while offering improvements, particularly in terms of diagnostic accuracy. We address the different ways that leveraging AI applications can reduce the carbon footprint associated with all types of capsule endoscopy examinations. Moreover, we contemplate how the incorporation of other technologies, such as blockchain technology, into digestive health care can help ensure the sustainability of this clinical speciality and by extension, health care in general.

Deep Learning and Minimally Invasive Endoscopy: Automatic Classification of Pleomorphic Gastric Lesions in Capsule Endoscopy

INTRODUCTION

Capsule endoscopy (CE) is a minimally invasive examination for evaluating the gastrointestinal tract. However, its diagnostic yield for detecting gastric lesions is suboptimal. Convolutional neural networks (CNNs) are artificial intelligence models with great performance for image analysis. Nonetheless, their role in gastric evaluation by wireless CE (WCE) has not been explored.

METHODS

Our group developed a CNN-based algorithm for the automatic classification of pleomorphic gastric lesions, including vascular lesions (angiectasia, varices, and red spots), protruding lesions, ulcers, and erosions. A total of 12,918 gastric images from 3 different CE devices (PillCam Crohn's; PillCam SB3; OMOM HD CE system) were used from the construction of the CNN: 1,407 from protruding lesions; 994 from ulcers and erosions; 822 from vascular lesions; and 2,851 from hematic residues and the remaining images from normal mucosa. The images were divided into a training (split for three-fold cross-validation) and validation data set. The model's output was compared with a consensus classification by 2 WCE-experienced gastroenterologists. The network's performance was evaluated by its sensitivity, specificity, accuracy, positive predictive value and negative predictive value, and area under the precision-recall curve.

RESULTS

The trained CNN had a 97.4% sensitivity; 95.9% specificity; and positive predictive value and negative predictive value of 95.0% and 97.8%, respectively, for gastric lesions, with 96.6% overall accuracy. The CNN had an image processing time of 115 images per second.

DISCUSSION

Our group developed, for the first time, a CNN capable of automatically detecting pleomorphic gastric lesions in both small bowel and colon CE devices.

Endoscopic methods for the detection and treatment of gastric cancer

PURPOSE OF REVIEW

The intent of this review is to describe new advances in endoscopic approaches to surveillance and management of gastric cancer.

RECENT FINDINGS

There are new endoscopic techniques and approaches that have improved the detection of gastric cancer, including narrow band imaging, confocal laser endocytomicroscopy and magnetically controlled capsule endoscopy. This article highlights the role of endoscopic submucosal dissection in the treatment of focal and diffuse gastric dysplasia and early gastric cancer with a discussion of indications, complications and outcomes. We review several recent guidelines addressing the surveillance strategies for individuals at high-risk for developing gastric cancer, such as those with atrophic gastritis and intestinal metaplasia, how gastric dysplasia and early gastric cancer can be endoscopically managed, and recommended surveillance after endoscopic intervention.

SUMMARY

Endoscopic approaches are evolving rapidly that will improve detection of dysplasia and early gastric cancer in high-risk individuals. Surveillance guidelines from various international societies reflect differences in local experience and prevalence of gastric cancer. Endoscopic submucosal dissection is now widely accepted as a first-line approach to early gastric cancers that can be resected en-bloc .

Clinical Benefits and Challenges in Application of Novel Portable Gastric Capsule Endoscopy for Home Healthcare Patients

Portable magnetic-assisted capsule endoscopy (MACE) provides satisfactory patient experience and safety with comparable performance in diagnosis of organic lesions when compared to conventional upper gastrointestinal endoscopy. In this study, a total of 58 homecare patients were included for MACE either in the hospital (n = 42) or at home (n = 16), with mean age of 71.1 ± 12.4 years. A total of 55 patients (94.83%) had completed the MACE with diagnosis of reflux esophagitis (43.6%), gastritis (54.5%), erosions (21.8%), fundic polyps (14.5%), peptic ulcers (25.9%), etc. Most patients (n = 47, 85.5%) were satisfied with the experience, and all patients who received MACE at home (n = 15, 100%) appreciated the convenience of endoscopy at home. Less than half of the patients (n = 24, 43.6%) could afford MACE if the expense was not covered by health insurance (USD 714). Time consumption from both traffic and capsule manipulation was also challenging for the physicians, as it took an average of 24.7 min to complete MACE, but it added up to a total of 92.7 min at home, which is about 15 times that of conventional endoscopy in hospital. More efforts are needed to ease the financial burden of patients, and optimization of workflow in community practice may help lift the obstacles revealed in this study.